GnRH-a降调节人工周期方案对不明原因反复种植失败患者妊娠结局的影响  

Effect of GnRH-a down-regulation combined with artificial cycle protocol on pregnancy outcomes in patients with unexplained repeated implantation failure

作　　者：袁彩霞[1] 胡凯伦 李蓉[2] Yuan Caixia;Hu Kailun;Li Rong(Department of Reproductive Medicine,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Reproductive Medical Center of Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]山西省人民医院生殖医学科,太原030012 [2]北京大学第三医院生殖医学中心,北京100191

出　　处：《中华生殖与避孕杂志》2023年第12期1216-1221,共6页Chinese Journal of Reproduction and Contraception

基　　金：国家杰出青年科学基金(81925013);山西省自然科学基金(20210302124304)。

摘　　要：目的探讨促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist, GnRH-a)降调节人工周期(artificial cycle, AC)方案对不明原因反复种植失败患者妊娠结局的影响。方法回顾性队列研究分析2018年1月至2019年12月期间北京大学第三医院生殖医学中心行冻融胚胎移植的不明原因反复种植失败患者的1 285个周期临床资料。按照子宫内膜准备方案的不同分成2组, GnRH-a垂体降调节AC组(记为GnRH-a+AC组, 411个周期)和AC组(874个周期)。比较2组患者的一般临床资料、周期特点和临床结局, 采用多因素logistic回归分析临床妊娠和活产的影响因素。结果 2组中一般资料比较差异均无统计学意义(均P>0.05)。GnRH-a+AC组患者内膜转化日子宫内膜厚度[(10.26±1.73)mm]比AC组[(9.66±1.54)mm]厚, 差异有统计学意义(P=0.002)。GnRH-a+AC组的临床妊娠率[42.58%(175/411)]、胚胎种植率[32.52%(200/615)]均高于AC组[35.59%(311/874), P=0.016;27.20%(346/1 272), P=0.017], 差异均有统计学意义;GnRH-a+AC组活产率[33.57%(138/411)]有增高趋势, 但与AC组[28.73%(251/874)]相比, 差异无统计学意义(P>0.05)。多因素logistic回归结果显示, 临床妊娠率与年龄、体质量指数(body mass index, BMI)呈负相关(OR=0.953, 95%CI:0.924~0.982;OR=0.959, 95%CI:0.926~0.994), 与GnRH-a方案呈正相关(OR=1.329, 95%CI:1.039~1.699);活产率仅与年龄、BMI呈负相关(OR=0.947, 95%CI:0.917~0.977;OR=0.963, 95%CI:0.927~0.999), 方案选择并未成为其影响因素(P>0.05)。子宫内膜厚度≥7 mm不是临床妊娠率和活产率的影响因素(均P>0.05)。结论对于不明原因反复种植失败患者, GnRH-a降调节联合AC方案可显著增加子宫内膜厚度, 改善患者的子宫内膜容受性, 提高患者胚胎种植率和临床妊娠率, 但在活产率方面虽有升高趋势但尚无统计学意义, 仍需大样本量进一步研究。Objective To investigate the effect of gonadotropin-releasing hormone agonist(GnRH-a)down-regulation combined with artificial cycle(AC)protocol on pregnancy outcomes in patients with unexplained repeated implantation failure(RIF).Methods The clinical data of 1285 frozen-thawed cycles of unexplained RIF patients who underwent frozen-thawed embryo transfer from January 2018 to December 2019 in the Reproductive Medical Center of Peking University Third Hospital were retrospectively analyzed.They were divided into two groups according to different endometrial preparation protocols:GnRH-a down-regulation combined with AC protocol group(named GnRH-a+AC group,411 cycles)and AC group(874 cycles).The general clinical data,cycle characteristics and clinical outcomes between the two groups were compared.Multiple logistic regression analysis was used to analyze the influencing factors of clinical pregnancy and live birth.Results There was no significant difference in the general data between the two groups(P>0.05).The endometrial thickness of GnRH-a+AC group[(10.26±1.73)mm]was thicker than that of AC group[(9.66±1.54)mm],and the difference was statistically significant(P=0.002).The clinical pregnancy rate[42.58%(175/411)]and the embryo implantation rate[32.52%(200/615)]of GnRH-a+AC group were higher than those of AC group[35.59%(311/874),P=0.016;27.20%(346/1271),P=0.017],and the differences were statistically significant.The live birth rate of GnRH-a+AC group[33.57%(138/411)]showed an increasing tendency,but there was no significant difference compared with AC group[28.73%(251/874),P>0.05].The multivariate logistic regression analysis showed that the clinical pregnancy rate was negatively correlated with age and body mass index(BMI;OR=0.953,95%CI:0.924-0.982;OR=0.959,95%CI:0.926-0.994),and positively correlated with GnRH-a protocol(OR=1.329,95%CI:1.039-1.699);the live birth rate was only negatively correlated with age and BMI(OR=0.947,95%CI:0.917-0.977;OR=0.963,95%CI:0.927-0.998)and GnRH-a protocol was not an influencing f

关 键 词：妊娠结局 反复种植失败 冻融胚胎移植 降调节人工周期方案 人工周期方案 

分 类 号：R714.8[医药卫生—妇产科学]